Provider Demographics
NPI:1710175781
Name:ROSEMONT ENTERPRISES INC
Entity Type:Organization
Organization Name:ROSEMONT ENTERPRISES INC
Other - Org Name:BAYNARD OPTICAL COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRENDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-655-1523
Mailing Address - Street 1:2323 PENNSYLVANIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1332
Mailing Address - Country:US
Mailing Address - Phone:302-655-1523
Mailing Address - Fax:302-655-6114
Practice Address - Street 1:2323 PENNSYLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1332
Practice Address - Country:US
Practice Address - Phone:302-655-1523
Practice Address - Fax:302-655-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1998206341332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1316010001Medicare NSC
DE1316010001Medicare PIN